Background: Though commonly used in the outpatient setting, patient portals have not been routinely used in hospital settings and their impact on patients’ knowledge and activation is largely unknown.
Methods: We created a patient portal mobile application which included pictures, names, and role descriptions of primary team members, scheduled tests and procedures, and a list of active medications in a health literacy sensitive format. We tested the effect of the portal in a cluster randomized controlled trial involving two similar teaching service units from May-October 2014. We randomly selected intervention unit patients on the morning of their second hospital day and offered them use of a tablet computer, with the patient portal, for the duration of their hospital stay. We conducted structured interviews of intervention unit patients and randomly selected control unit patients during the afternoon of patients’ second or third hospital day. We excluded patients who were disoriented or did not speak English. Patients were asked to name their primary service physicians, physician roles, planned tests and procedures for the day, medications started, and medications stopped since admission. We recorded patients’ verbatim responses and compared them, in a blinded fashion, to data collected from patients’ physicians and the medical record to determine whether patients had no, partial, or complete knowledge for each aspect of the plan of care. We assessed patient activation using the Short Form of the Patient Activation Measure (PAM-SF).
Results: Overall, 100 intervention and 102 control unit patients participated in the study. Use of the patient portal application varied among intervention patients, with 56.6% using it more than once per day and 20.2% never using it. A higher percentage of intervention unit patients correctly named ≥1 physician (56.0% vs. 29.4%; p<0.001) and ≥1 physician role (47.0% vs. 15.7%; p<0.001), but knowledge of tests, procedures, and medications was not significantly different. The PAM-SF score was higher among intervention unit patients, but the result was not statistically significant (64.1± 13.4 vs. 62.7±12.8; p=0.46). We repeated analyses comparing patients who used the portal more than once per day to all other patients. A higher percentage of patients who used the portal more than once per day had complete knowledge of new medications (22.8% vs. 10.3%; p=0.02) and discontinued medications (57.9% vs. 43.5%; p=0.06). Patients who used the portal more than once per day had higher PAM-SF scores (66.5±13.3 vs. 62.0±12.8; p=0.03). In multivariable models adjusting for key demographic differences, patients who used the portal more than once per day were more likely to have complete knowledge of new medications (OR=3.0; p=0.01) and higher PAM-SF (ß=5.0; p=0.02).
Conclusions: Hospitalized patients’ use of a patient portal improves knowledge of team members and appears to improve knowledge of medications and patient activation.